The Cardiac Arrest Patient & Worst-Case Scenario

I have run hundreds of codes in my years of teaching ACLS. I’d even go so far as to say I’m pretty good at running a code.

Out of 100 patients who go into cardiac arrest outside the hospital, what percentage of them do you think will live to discharge?

The best literature says 2%.

In hospital, 17%.

What is most critical for code teams?ID-100162272

If someone comes in and they are in cardiac arrest, what is the worst-case scenario?

The patient is probably going to die. You just read the numbers.

The worst-case scenario is actually a chaotic, stressed process that doesn’t run smoothly. Focus on these three things and you can avoid the worst-case scenario:

  1. Stay calm. This seems like a no-brainer, but when you’re in the heat of the moment it can be easy to forget. Your very first rule of running a code team is to be calm and keep your team calm.
  2. Focus. The worst-case scenario is that my team becomes less functional for the next code that comes in the door. As the leader of a code team, it’s my job to run the team and make sure the team is focused. To be sure we are efficient and understand that although saving this patient might not be viable, the next one may be – so my whole goal in running the code is to run an incredibly smooth code where we are focused and everything runs smoothly.
  3. Get better. On every code, maybe we get a percentage or two better because we are calm and focused. It’s only human nature for people to get anxious when a cardiac arrest comes in, but focusing on the first two bullets means that as individuals and as teams, we continue to get better.

Stay calm, focus and stick to the process. You will get better and the team will get better. And ultimately, that means we’ll save more lives and be stronger medical professionals.

Image courtesy of FreeDigitalPhotos.net/praisaeng

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John Bielinski, Jr., MS PAC is a practicing emergency medicine clinician, and has been lecturing nationally for more than ten years, teaching the tactics that have proven invaluable in his career as a medical professional.
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